Social Skills for Daily Living Checklist

Student:__________________________
Social Skills for Daily Living Checklist
Date:_____ Rating:_____
Date:_____ Rating:_____
Date:_____ Rating:_____
Date:_____ Rating:_____
Rating Scale:
1= Does not/cannot perform task
2= Performs task with full assistance
3= Performs task with partial assistance
4= Performs task independently
Social Skills for Daily Living
1 The student will respond orally or with appropriate 1 2 3 4
gesture when greeted by peer or adult
2 The student will shake hands and give his name
1 2 3 4
when meeting a person for the first time.
3 The student will take turns during a conversation. 1 2 3 4
4 The student will keep his head up during
1 2 3 4
conversations.
5 The student will maintain eye contact during
1 2 3 4
conversations.
6 The student will say “thank you” and “ please”
1 2 3 4
appropriately.
7 The student will demonstrate appropriate listening 1 2 3 4
skills
(eye contact, body language, personal space).
8 The student will ask for help appropriately when
1 2 3 4
needed.
9 The student will listen to others without interrupting. 1 2 3 4
10 The student will maintain appropriate personal space 1 2 3 4
when
Interacting with peers and adults.
11 The student will maintain appropriate voice level 1 2 3 4
during conversations.
12 The student will identify basic emotions expressed 1 2 3 4
by others.
13 The student will take a simple message and deliver it 1 2 3 4
to the right person.
14 The student knows and can state basic personal
1 2 3 4
information ( name, address, phone number, age)
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1 2 3 4